Republicans' Real Problem with Health Care (and Education and Everything Else)

Here is the Republican Party's real problem.  It holds some views that, if put into actual practice, would be highly disruptive and cause, at a minimum, serious short-term suffering.  It has a substantial base of followers who adhere to its views as an abstract proposition.  But there are a whole lot fewer who are prepared to deal with the real world consequences.

This, I think, is what underlay the 1995 government shutdown.  The Republicans won the 1994 election by denouncing government as an evil monster, crushing liberty under its iron heel and draining our life blood while giving us nothing in return.  It proved a highly popular campaign.  So naturally Republicans assumed that if government was an evil monster, crushing liberty under its iron heel and draining our life blood while giving us nothing in return, shutting down this monstrosity would be popular.  And as for any inconveniences involved, well they would be a small price to pay for freedom.  Its supporters, by contrast, assumed that if government was an evil monster, crushing liberty under its iron heel and draining our life blood while giving nothing in return, shutting it down would not be accompanied by any serious inconvenience.

And such has been the Republican Party's dilemma ever since.  The share of the population that regards the government as an evil monstrosity that should be crushed to dust with a jackhammer is a good-sized voting bloc -- about 30% of the population.  The share of the population that is prepared to tolerate even a minor inconvenience in pursuit of this goal is a lot smaller.  And the share that is willing to suffer serious inconvenience like, say, the loss of Medicare is minuscule.

Or consider Governor Sam Brownback of Kansas.  He was elected on a promise to make deep cuts in taxes.  And he did.  Now everyone is shocked, shocked that the tax cuts have led to massive deficits and are forcing major cutbacks on education.  To which I can only say, well, duh!  Haven't you ever heard of Starve the Beast.  Republicans have two rationales for why taxes should always be cut.

1. Supply side economics.  Tax cuts will spur such growth that revenue will increase and on spending cuts will be necessary.
2. Starve the beast.  Tax cuts will choke off revenue, precipitate a fiscal crisis, and finally force spending cuts.

Granted, they can't both be true.  But they can be a game of heads I win, tails you lose.  Either way, tax cuts are justified.  It's just that when the beast starts getting really hungry, announcing that your plans to starve it tend to be unpopular.  Quite simply, Brownback has plenty of backers -- some libertarian, some Evangelical Christian -- who consider public schools illegitimate and want to starve them.  (Evangelicals so churches can run the schools and libertarians so anyone but government can run the schools).  But now that it is beginning, apparently no one has the courage to come right out and say so.

The parallels with Obamacare are obvious.  Republican wonks/think tanks/donors/activists have a large libertarian contingent who believe that government providing paying for anyone's health care (except possibly through county indigent funds) is absolute evil.  There is some disagreement whether the evil because it "enslaves" recipients by fostering dependency in them or because it "enslaves" taxpayers by forcing them to pay for healthcare (which is functionally no different from dragging them from their beds in the middle of the night and forcing them to empty bedpans at gunpoint).  But either way, government paying for anyone's healthcare is morally unacceptable and must be stopped.  Stripping millions of their health insurance is acceptable because in the long run, the free market will come up with something better.  And we are all dead in the long run and loss of health insurance means the long run will come sooner for some people -- well, either you are better off dead than enslaved by dependency, or whether you live or die is less important than not allowing you to enslave taxpayers.

But this is stronger medicine than most people, including much of the Republican base, are prepared to take.  Or to impose on others.  And the proof of this is in the behavior of Republican state governors.  Many Republican governors have refused the Medicaid expansion.  But invariably they have given some sort of excuse like fear that it will strain the state budget in the future.  None have come right out and said that they don't want anymore poor people to have health insurance, or that poor people are better off dead than dependent.  Likewise, governors who have refused to build exchanges have given a wide variety of excuses, but keeping people from getting insurance has never been one of them.  You don't hear the governor of Tennessee calling a press conference to boast that while Kentucky has seen its rate of uninsured fall by half, Tennessee has widely avoided that horror. Nor do you hear Sam Brownback boast that his modifications to Medicaid have actually increased Kansas' rate of uninsured.  Or when Texas was cutting off funding to Planned Parenthood, no one ever boasted that they were cutting off women's access to healthcare; rather the response was to deny it.

In short, the Republican Party lacks the courage of its convictions, or at least the courage to speak them out loud in public.  Instead, it prefers to deny even the most obvious consequences of its actions.  And there is one serious problem with ignoring reality.  Reality won't go away just because you pretend it isn't there.  If your most cherished initiative is an attempt to strip millions of their health insurance, don't be surprised that if it succeeds millions lose health insurance.  Or that you find yourself under immense pressure to do something about it.